WASHINGTON – The Department of Justice announced today that it has filed a lawsuit against the state of Louisiana and a number of Louisiana state agencies and officials alleging that the state has violated its obligations under the National Voter Registration Act (NVRA).

The complaint, filed today in the U.S. District Court for the Middle District of Louisiana, alleges that Louisiana has violated the NVRA by failing to provide voter registration services at offices providing public assistance and serving persons with disabilities in Louisiana. Specifically, the complaint alleges that Louisiana officials have not routinely offered voter registration forms, assistance and services to the state’s eligible citizens who apply, recertify or provide a change address for public assistance or disability services, or benefits.

July 08, 2011

People with disabilities from across the country watched, listened to, and questioned AAPD's new President and CEO in our first ever Virtual Town Hall on June 29. The event was also live tweeted at @AAPD. If you were not able to participate on the day of the event, you can still watch and listen to the event which has been captioned and posted to YouTube. Topics of discussion included voting, employment, Medicaid cuts, and more. Viewers asked questions about getting involved in the legislative and electoral processes and how to improve educational access for kids with disabilities. The discussion was lively and informative. Furthermore, Mark shared his vision for our organization and his plan include more town halls. So check out this event and check back for information about the next town hall.

This month marks the 12th anniversary of the Supreme Court’s landmark decision in Olmstead V. L.C., ruling that the needless institutionalization of people with disabilities is illegal discrimination. Despite that decision, misguided Medicaid rules continue to force millions of people with disabilities to remain in nursing homes, against their wishes and at a much greater cost to taxpayers than many home and community-based alternatives.

Today, as we seek ways to reduce budget deficits, we must seize on the opportunity to make our Medicaid dollars go farther while finally giving millions of individuals with disabilities one of the most fundamental of rights: the choice to live independently.

The Olmstead decision is sometimes called the Brown v. Board of Education for people with disabilities. It questioned the widespread practice of forcing people with disabilities to live in segregated settings in order to receive services, and it opened the door for people with disabilities to live full lives and participate in their communities.

Adhering to the ADA’s “integration mandate” not only allows people to live the same kinds of lives that the rest of us do, but actually saves money...

On June 21, 2011, AAPD learned that the U.S. House Energy and Commerce Subcommittee on Health held a hearing to discuss “Dual-Eligibles: Understanding This Vulnerable Population and How to Improve Their Care.” This hearing focused on restructuring Medicare and Medicaid to be more effective and cost efficient for the 9 million Americans who qualify for both programs, beneficiaries commonly referred to as dual-eligibles.

Of these 9 million dual-eligibles, one third, or three million are people with disabilities. About two-thirds are elderly people. 43 percent of dual-eligibles have at least one mental or cognitive disability, while 60 percent have multiple chronic conditions. AAPD is very concerned about the three million people with disabilities who are dual eligibles as current discussions focus on capping, cutting or otherwise limiting the amount of funds both these programs receive.

The House Subcommittee on Health is chaired by Joe Pitts (R-PA) and the Ranking Member is Frank Pallone (D-NJ). Subcommittee chairman Pitts said, in his opening statement, “Dual eligibles are unique. …. more than half of dual eligibles live below the poverty line … [and] nineteen percent of dual eligibles live in an institutional setting.” Pitts added that dual-eligibles “are also more likely to be hospitalized, to go to emergency rooms, and to require long-term care than other Medicare beneficiaries.” Citing to the Kaiser Foundation statistics he said “ ... dual eligibles – who make up only 15 percent of Medicaid enrollment – consume 39 percent of total Medicaid spending.”

Ranking Member Pallone said “Congress and this Committee are increasingly concerned about the rising cost of Medicare health care coverage for the 45 million elderly and disabled Americans and Medicaid’s 55 million poor patients. So what better place to explore, understand and address than the sickest and most expensive populations to cover.” Pallone also said, “But we mustn’t set a price tag on their care nor should we shape policy with the goal of only saving money.”

Melanie Bella, Director of the Federal Coordinated Health Care Office Centers for Medicare and Medicaid Services (CMS) said benefits were provided totaling $120 billion in 2007 and this is increasing. This amount is twice as much as Medicaid spent on the 29 million children it covered that year.

Bella explained that since Medicare and Medicaid were designed each as individual programs that is the cause of many problems today. Since the two programs were not designed to be readily compatible, it is difficult for beneficiaries to navigate both sets of requirements, often resulting in fragmented and sub-optimal treatment, she said.

Bella said that CMS is working to make the two programs more user-friendly for dual-eligibles. These initiatives focus on patient-centered medicine that would hopefully lower costs through preventing or avoiding costly interventions. CMS hopes to do this through better state and federal coordination, learning from patient focus groups, and state-wide experimental initiatives that could be scaled to the national level if successful.

Four representatives from state and national programs that are currently providing medical coverage to dually eligible beneficiaries also spoke. These programs were presented as examples of how to solve the problems faced by beneficiaries who are dually eligible.

Billy Millwee, Associate Commissioner for Medicaid/CHIP, from the Texas Health and Human Services Commission spoke about a Texas state program called STAR+PLUS. The program features integration of acute care and long term support services, which Medicare and Medicaid currently do not provide. Additionally, STAR+PLUS partners with medical providers that take full financial and well-being responsibility, using financial incentives to lower overall costs.

Robert Egge, Vice President of Public Policy from the Alzheimer's Association, discussed the need for more support of unpaid caregivers and simplification of the Medicare and Medicaid systems. He urged the Subcommittee to remember that a large portion of the dual-eligible population has Alzheimer’s or dementia of some sort. In order for participants to have cohesive and comprehensive care, they must be able to easily navigate the medical system, he said.

President and Chief Executive Officer, Shawn Bloom, from National PACE Association, or the Program of All-inclusive Care for the Elderly outlined how and why her organization was considered the “gold standard” by government and private evaluations. Their programs are focused on community-based support that keeps the older population, above 65, out of nursing homes for as long as possible. She said that through patient-centered medicine -- as Bella advocated for -- PACE cuts costs while raising quality of care. Significantly, Bloom asked the Subcommittee to provide resources for dual-eligibles who are under 65 years of age, such as people with disabilities, to participate in PACE programs.

Lastly, Denise Levis Hewson, Director of Clinical Programs and Quality Improvement from Community Care of North Carolina (CCNC), emphasized the importance of local, personal care. CCNC functions by having the patient’s primary care physician direct all of his or her medical care. By having the primary care physician at the center, care is cohesive and comprehensive. Hewson stated her program “achieves ‘the triple aims’ of improving the health care of the dual population, improving the quality, access and reliability of care, and reducing the costs of care.” This appeared to be the goal of Subcommittee and panel members alike.

Outlook: It is unclear how this hearing will affect future policy changes in Medicare and Medicaid although it appears CMS could sponsor more initiatives or make national some of the newer approaches. However, disability advocates note that any federal entitlement programs that are expanding are being looked at very closely in the current conversations about the deficit, the debt limit and the budget for 2012.

1. If you are, or know someone who is, a beneficiary of both Medicare and Medicaid and you are a person under age 65 with a disability, and have encountered problems with the two programs, please let us know about them, either by commenting in the box below or email to policy@aapd.com

2. If you have had experience with any of the programs discussed above, such as in Texas or North Carolina, please tell AAPD more about this by commenting in the box below or email to policy@aapd.com

The National Council on Independent Living (NCIL) is very proud and excited to announce that a bill has been filed with the Senate HELP Committee which creates the establishment of a new Independent Living Administration (ILA), and strengthens America’s Independent Living (IL) Program. The ILA would elevate the IL Program at the federal level, and would create an organization independent of the Rehabilitation Services Administration (RSA) within the Department of Education.

The creation of this new administration marks a truly historic moment in the Independent Living Movement, and IL advocates across the country have much to celebrate this week.

The ILA is created through the reauthorization of the Rehabilitation Act of 1973, which is contained in the larger Workforce Investment Act (WIA). NCIL has been pushing for the reauthorization of WIA and the Rehabilitation Act for nearly a decade, and the introduction of a bill to reauthorize both pieces of legislation presents a unique opportunity to improve the IL Program and substantially increase consumer-control at the federal level.

June 27, 2011

Recently, the ADA Amendments Act was signed into law, and I was proud to be its chief sponsor. When it is enacted in early 2009, the legislation will allow us to fulfill the original promise of the Americans with Disabilities Act.

As you may know, the ADA was one of the landmark civil rights laws of the 20th century, and helped us make enormous progress in advancing the four goals of the ADA: equality of opportunity, full participation, independent living and economic self-sufficiency.

Despite these strides, we have left some people with disabilities behind. The problem is a series of Supreme Court decisions, which have greatly narrowed the scope of who is protected by the ADA. First of all, these cases held that mitigating measures, such as medication, prosthetics, or other assistive devices, must be considered in determining whether a person has a disability under the ADA. Secondly, they asserted that there must be a demanding standard in assessing whether an individual has a “disability.”

As a result, people with conditions that common sense tells us are disabilities, are being told by courts that they are not disabled, and thus not eligible for protections under the law...

June 24, 2011

Reduced Federal Medicaid Payments in 2012: Many States Already Cutting Back

By David Heymsfeld, AAPD Policy Advisor

In recent weeks supporters of Medicaid have focused on advocating against proposals, such as block grants and global spending caps, which could lead to drastic reductions in future federal funding of Medicaid. The threats of these proposals have obscured the fact that even if none of these proposals are enacted there are provisions in existing law which will result in less spending for Medicaid in 2012 than in 2011. In many states this is likely to lead to reduced Medicaid services including for people with disabilities and their family members.

Background: In the Medicaid program, each state establishes its own program although it must work within federal requirements. The federal government helps fund each state’s program, with the federal share averaging about 57%. Medicaid is the largest expense in state budgets, and constituted about 22% of total state spending in 2010.

Federal Cutbacks Taking Effect on July 1, 2011: As you may recall, there was legislation passed in 2009 to combat the recession, that is, the American Recovery and Reinvestment Act, also referred to as “the stimulus.” This temporarily increased the federal share for Medicaid by about 10%, resulting in the states receiving about $87 billion in increased funding. This increased rate of funding ends on July 1, 2011. However, at the same time, the needs are growing. For instance, as a result of the recession, Medicaid enrollment increased by 8% in 2010, with estimated growths of 5% in 2011 and 4% in 2012.

With federal funding to be reduced by 13% in Fiscal 2012, most states are planning some increases in their own funding, but not enough to close the gap. Overall Medicaid funding is expected to decrease 3%. With the lower funding, most states are planning some changes to limit costs of their programs.

How States Cut their Medicaid Programs: These changes include reduced provider payments in 33 states, making it more difficult for Medicaid patients to find providers willing to treat them. Other measures include limitations on benefits to be carried out in 25 states. Another 13 states will put limitations on prescription drugs. New or higher co-payments will occur in 21 states and there will be expansions of managed care in 19 states. In fact, many states are proposing more than one of these changes. For instance, Table 29 (page 57) lists which states have cut or plan to restrict community-based care (CA, MN, NY, WA).

Note that the so-called Maintenance of Effort (MOE) provisions included in the health care reform Act prevent the states from making other changes such as increasing income eligibility levels or otherwise making it more difficult for individuals to apply.

This will give you some sense of what your state is looking at in regard to Medicaid. For instance, Table 28 shows some specific strategies states are using. Note also that the states are considering ways to increase revenues (Table 30).

Contact your governor’s office or state legislator to learn about specific proposals to cut back Medicaid in your state.

Protest early and often any cuts that are unfair to people with disabilities or revenue enhancements that unfairly burden people with disabilities and their families.

The Justice Department today filed papers seeking to intervene in Steward, et al. v. Perry, et al., a case filed on behalf of thousands of Texans with developmental disabilities to enforce their right under the Americans with Disabilities Act (ADA) to receive services provided by the state in the most integrated setting appropriate to their needs...

The proposed complaint by the United States, which must first be approved for filing by the U.S. District Court in San Antonio alleges that Texas unnecessarily segregates individuals with developmental disabilities in nursing homes instead of providing them the opportunity to receive integrated, community-based services. The proposed complaint also alleges that Texas places individuals with developmental disabilities who currently live in the community at risk of unnecessary placement in nursing facilities by failing to provide necessary community-based services in violation of the ADA and Section 504 of the Rehabilitation Act...

WASHINGTON – The Department of Justice released a new technical assistance document describing public entities’ obligations and individuals’ rights under the integration mandate of title II of the Americans with Disabilities Act (ADA) and the 1999 landmark Supreme Court decision, Olmstead v. L.C. The Olmstead decision held that the ADA requires public entities to provide community-based services to persons with disabilities when such services are appropriate; the affected persons do not oppose community-based treatment; and community-based services can be reasonably accommodated. The document also provides questions and answers on a variety of ADA enforcement issues related to Olmstead.

Additionally, in commemorating the 12th anniversary of the Olmstead decision yesterday, the department launched a new section of its ADA website, www.ada.gov/olmstead, providing information and resources about the decision and its enforcement. In addition to the newly created technical assistance document, users can visit the site to find briefs filed by the Department, as well as other materials relevant to this important area of law.

The ADA website provides easy access to an extensive collection of ADA technical assistance materials and settlement agreements, as well as information about enforcement, mediation, technical assistance and certification activities and links to other sites with ADA information. The addition of the new Olmstead section of the site will provide critical information to individuals with disabilities, advocates and state and local officials responsible for complying with the ADA’s integration mandate...

June 23, 2011

The memories of living in institutional settings since the age of 13 will always be with Lois Curtis even though her life today is beyond what she ever could have imagined when she made the first of many brave phone calls to my office at the Atlanta Legal Aid Society saying, “I want to get out!” The journey (and struggle) from that day includes an historic Supreme Court decision, a home of her own and a successful career as an artist. And now, a meeting with President Barack Obama in the Oval Office as we observe the 12th anniversary of the Olmstead decision.

The Olmstead story began long before the Supreme Court decision. Lois and another plaintiff, Elaine Wilson (who passed away in 2004), were in a state psychiatric hospital in Georgia. They filed suit in 1995 seeking disability services in the community...

...And, as we all now know, the U.S. Supreme Court eventually held that the unjustified institutional isolation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act, thus taking a giant step forward for the millions of people with disabilities across the country.

Lois’ story did not end after that landmark Supreme Court decision. In fact, that decision launched a new journey. After living in staffed residential homes since her release from the institution, Lois now rents a beautiful home in the Stone Mountain area of Georgia...

Frankie Mastrangelo is the moderator for both the Justice For All (JFA) national email listerv as well as for the JFActivist blog. She is also an organizer for the American Association of People with Disabilities in Washington, D.C.